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Septic Arthritis and Acute Rheumatic Fever in Children: The Diagnostic Value of Serological Inflammatory Markers.
[acute rheumatic fever]
Joint
pain
and
raised
inflammatory
markers
are
features
of
both
acute
rheumatic
fever
(
ARF
)
and
septic
arthritis
,
often
posing
a
diagnostic
challenge
to
clinicians
.
Important
differences
in
the
presenting
serological
inflammatory
marker
profile
may
assist
patient
diagnosis
,
however
,
as
clinical
experience
suggests
that
ARF
is
associated
with
a
higher
erythrocyte
sedimentation
rate
(
ESR
)
,
whereas
other
serological
markers
may
be
similarly
elevated
in
these
2
conditions
.
The
goal
of
this
study
was
to
determine
the
diagnostic
value
of
serological
inflammatory
markers
and
white
cell
count
(
WCC
)
in
children
presenting
with
acute
joint
pain
secondary
to
ARF
or
septic
arthritis
.
Data
were
obtained
from
the
Auckland
regional
rheumatic
fever
database
and
hospital
computer
records
between
2005
and
2012
.
Records
of
all
patients
under
the
age
of
16
years
who
were
admitted
with
a
new
diagnosis
of
ARF
or
septic
arthritis
were
analyzed
.
The
diagnosis
of
ARF
was
defined
on
the
basis
of
the
New
Zealand
modification
of
the
Jones
Criteria
,
and
the
diagnosis
of
septic
arthritis
was
defined
on
the
basis
of
joint
fluid
cytology
and
culture
.
Baseline
characteristics
,
serological
inflammatory
markers
,
and
serum
WCC
were
compared
between
the
ARF
and
septic
arthritis
patient
groups
.
Children
with
ARF
displayed
significantly
higher
ESR
,
higher
serum
C-
reactive
protein
,
and
lower
serum
WCC
than
children
with
septic
arthritis
on
presentation
to
hospital
.
In
children
presenting
with
monoarthritis
,
an
ESR
>
64
.
5
,
serum
WCC
<
12
.
1
×
109
/
L
,
and
age
above
8
.
5
years
were
found
to
be
significant
independent
predictors
of
ARF
.
Children
with
all
3
predictors
had
a
71
%
risk
for
ARF
and
a
29
%
risk
for
septic
arthritis
.
A
significant
proportion
(
30
%
)
of
children
with
the
final
diagnosis
of
ARF
initially
presented
with
monoarthritis
;
14
%
of
these
children
(
5
/
34
)
had
received
nonsteroidal
anti-
inflammatory
medication
before
hospital
presentation
,
and
74
%
of
these
children
(
25
/
34
)
had
abnormal
echocardiograms
on
admission
.
ARF
and
septic
arthritis
are
important
diagnoses
to
consider
in
children
presenting
with
acute
joint
pain
in
New
Zealand
.
A
significant
proportion
of
patients
with
ARF
initially
present
with
acute
monoarthritis
.
Serological
inflammatory
markers
and
WCC
on
presentation
differ
significantly
between
children
with
ARF
and
septic
arthritis
.
Diseases
Validation
Diseases presenting
"joint pain"
symptom
acute rheumatic fever
oligodontia
typhoid
This symptom has already been validated
